Regional Pain - Treatment

By treatment is meant gradually increasing resistance and flexibility. Strategies include improving the pharmacological treatment of pain, sympatholytic interventions and rehabilitation. All treatments have to follow the restoration of function. The use of drugs, sympathetic blocks, and psychotherapy help to control pain.Early medical intervention is important for its success. The duration between the onset of treatment and clinical improvement varies from several days to several years.
Physical Therapy:It is important for these patients to establish a steady progression from supporting a minimum weight until the weight normal for the affected limb. Desenzitivizarea gradually to increase sensory stimuli also plays an important role. Physical therapy in combination with the Occupational play an important role in restoring function. It aims to increase strength and flexibility gradually. These patients have co miofasciala pain can be treated with relaxation techniques and massage miofasciala.
Occupational therapy:It involves placing and maintaining a mechanical loading gymnastics program for patients with regional pain syndrome. This program involves active compression and relaxation that stimulates the affected extremity without joint movement. Sponge technique gradually apply pressure on the region affected by mechanical friction. The next phase of this program involves wearing a weightlifting technique by patients affected extremity.
Surgery:Sympathetic blocks:For upper extremity impairment of stellate ganglion block is recommended. Bupivacaine is preferred to lidocaine due to longer duration of action. Not all patients have improved after this intervention. Percutaneous catheter placement in lumbar sympathetic plexus and Drug Administration relieves pain in most patients with long-acting.Bier Block: Intravenous regional:The practice block or reserpine bretilinium with profound effect and duration of 2-3 days. Somatic block consists of continuous epidural infusion with different variants of brachial plexus block with axillary approach, supraclavicular or infraclavicular.Spinal cord stimulator:Pain located at the end can be ameliorated by a stimulating dispizitiv spinal cord. Neurostimulatorul can be surgically implanted to reduce pain by directly stimulating the spinal cord. These devices place electrodes in the epidural space or in the nerves and releases electrical shock.Injections of local anesthetics such as lidocaine is the first step in treatment. Injections are repeated as necessary.Intrathecal infusion:The practice of continuous infusion pump through a direct intrathecal morphine, baclofen, bupivacaine.Sympathectomy:If a sympathetic block produces a significant improvement in pain, radiofrequency denervation or crioproba bring long term relief.Cervicotoracica endoscopic surgical sympathectomy is to make efficient upper extremity. The practice and chemical sympathectomy.
Pharmacological Therapy:Pain regional pain syndrome are divided into two categories:Opioids:-Are used as an analgesic for many pain syndromes-Opioid therapy is safe and a good option for patients with and without pain nonmaligna history of drug abuseHigh-doses of tramadol benefits for neuropathic pain, allodinia.NSAIDs:, Acetaminophen is a safe option for treating pain during pregnancy and lactation.Antidepressants:-Plays an important role in treating neuropathic painThe use of antidepressants trociclice: doxepin, amitriptyline-Serotonin reuptake inhibitors: sertalina-Anticonvulsants.For patients who can not be treated with narcotic analgesia practice of neural blockade, although neuropathic pain can be very resistant to standard analgesics. Patients who failed to neural blockade may have disease that has progressed to stage independent sympathetic.
Prognosis:Evolution of patients can be good if treatment is begun early, ideally within the first 3 months after onset. If treatment is delayed condition is rapidly expanding to the entire member and changes in bone, skin and nerves become irreversible. Member may suffer muscle atrophy, loss of function and amputation.